DOI: 10.25881/BPNMSC.2020.60.67.016


Fajzrahmanov R.R., Pavlovskij O.A., Larina E.A., Suhanova A.V.

Pirogov National Medical and Surgical Center, Moscow


Backgraund: recently, negative properties of internal limiting membrane peeling have been proven, associated with additional microtraumatization of neuroretinal tissue due to its close connection with the inner layers of the retina and with Muller cells. These factors affect insufficiently high functional results after surgery when closing the macular hole.

Aims: purpose of the study was to propose a new technique for surgery for macular hole, which is based on the preservation of ILM and to assess the dynamics of the functional parameters of the retina.

Materials and methods: The results of surgical treatment of 140 patients (140 eyes) diagnosed with macular hole were analyzed.

Group 1 (70 eyes) — patients who underwent surgical treatment using the introverted flap technique.

Group 2 (70 eyes) — patients who were operated on according to the original method with preservation in the ILM in the Central zone. All patients underwent standard ophthalmological examinations before and after surgery, including visometry, biomicroscopy, ophthalmoscopy, and OCT.

Results: In the course of the study, 4 types of macular zone repair options were identified and studied after surgical treatment for macular hole.

When studying morphological changes in macular hole repair by the «pseudocyst» type in patients of both groups, it demonstrates a more pronounced resistance of neuroretinal tissue in patients of group 1. In group 2, a more pronounced dynamics of reduction of morphological parameters of the hyporeflective defect was revealed during the entire observation period. When the macular gap is completely closed, there is a higher rate of regression of neuroepithelial tissue edema in group 2 patients. The formation of rough scar tissue was observed only in patients of group 1.

Conclusions: the highest functional parameters were obtained when closing the macular hole with the formation of retinal tissue. With this type of repair, higher morphofunctional parameters were achieved in group 2 patients. Based on this study, it can be concluded that there is no intraoperative damage to the retinal layers in the PM, which provides higher morphofunctional parameters.

Keywords: мacular hole 1, pilling 2, OCT 3.


1. Alpatov SA, Shchuko AG, Malyshev VV. Patogenez i lechenie idiopaticheskikh makulyarnykh razryvov. Novosibirsk: Nauka; 2005.

2. Faizrakhmanov RR, Pavlovskii OA, Larina EA. Khirurgicheskoe lechenie patsientov s neustranennym makulyarnym razryvom. Vestnik Natsional'nogo mediko-khirurgicheskogo Tsentra im. N.I. Pirogova. 2019;2(14):98–104. Doi: 10.25881/BPNMSC.2018.64.37.021.

3. Faizrakhmanov RR. Rezhimy naznacheniya anti-VEGF-preparatov pri terapii neovaskulrnoi vozrastnoi makulyarnoi degeneratsii. Vestnik oftal'mologii. 2018;(6):105–113. Doi: 10.17116/oftalma2018134061107.

4. Balashevich LI, Baiborodov YaV, Zhogolev KS. Vitreomacular interface pathology. Review of foreign literature in questions and answers. Fyodorov Journal of Ophthalmic Surgery. 2014;(4):109–114.

5. Neroev VV, Zueva MV, Bychkov PA, et al. Dinamika funktsional'noi aktivnosti setchatki pri khirurgicheskom zakrytii idiopaticheskikh makulyarnykh razryvov. Oftal'mologicheskie vedomosti. 2013;4(6):21–27. Doi: 10.17816/ov2013421-27.

6. Michalewska Z, Michalewski J, Dulczewska-Cichecka K, et аl. Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: A Comparative Study. Retina. 2015;35(9):1844–50. Doi: 10.1097/IAE.0000000000000555.

7. Shkvorchenko DO, Zakharov VD, Shpak AA, et al. Nash opyt primeneniya bogatoi trombotsitami plazmy krovi v khirurgii makulyarnykh razryvov. Sovremennye tekhnologii v oftal'mologii. 2016;(1):245–246.

8. Lyskin PV, Zakharov VD, Lozinskaya OL. Patogenez i lechenie idiopaticheskikh makulyarnykh razryvov. Evolyutsiya voprosa. Oftal’mokhirurgiya. 2010;(3):52–55.

9. Belyi YuA., Tereshchenko AV, Shkvorchenko DO. Khirurgicheskoe lechenie bol'shikh idiopaticheskikh makulyarnykh razryvov. Prakticheskaya meditsina. 2015;1(2):119–123.

10. Faizrakhmanov RR, Pavlovskii OA, Larina EA. Metod zakrytiya makulyarnogo razryva s chastichnym sokhraneniem vnutrennei pogranichnoi membrany: sravnitel'nyi analiz mikroperimetricheskikh dannykh. 2019;17(20):187–200.

11. Gerardo GS, Verena J, David Ch. Topical steroids: A non-surgical approach for recurrent macular holes. Am J Ophthalmol Case Rep. 2018;18(13):93–95. Doi: 10.1016/j.ajoc.2018.12.014.

12. Schumann RG, Yang Y, Haritoglou C, et al. Histopathology of Internal Limiting Membrane Peeling In Traction Induced Maculopathies. J Clin Exp Ophthalmol. 2012;3(4). Doi: 10.4172/2155-9570.1000224.

13. Faizrakhmanov RR. Anti-VEGF terapiya neovaskulyarnoi vozrastnoi makulyarnoi degeneratsii: ot randomizirovannykh issledovanii k real'noi klinicheskoi praktike. Russian Ophthalmological Journal. 2019;2(12):97–105. (In Russ).] Doi: 10.21516/2072-0076-2019-12-2-97-105.

For citation

Fajzrahmanov R.R., Pavlovskij O.A., Larina E.A., Suhanova A.V. Comparative analysis of morphological parameters of reparative activity of the foveolar zone under various methods of closing the macular hole with plasticity of the internal limiting membrane. Bulletin of Pirogov National Medical & Surgical Center. 2020;3-2(15):86-91. (In Russ.)